"REPORT OF CHANGE OF BASE ASSIGNMENT"
REPORT OF CHANGE OF BASE ASSIGNMENT 1. Social Security Number Last Name First Name Initial 2. Purpose: To document continuous service during a school year for full-time employees who U U a) start at the usual beginning date of a contract, b) finish the year at the end of a contract, and c) have no missed workdays between the contracts, i.e., workdays are continuous from the beginning of the first contract to the end of the last with the same employer. This data is necessary to insure proper service credit for the member. Submit this form as soon as the change occurs. Definition of Change of Base: A contract change during the year, where the full-time (FT) base year of the 2 nd U U P P contract is of a different length from the first. County Code District Code 3. First change of base in fiscal year - Second, third…change of base in FY - Correction for previous C of B in FY - 4. Assignment Data: Partial Year Full-Time Required % of CalSTRS Service Period Service Days Contract Annual Comp. USE Assignment Full Part If Multi. Beginning Ending Earnable Year Year Simul. ONLY Date Date Position a) b) c) d) e) f) g) h) (mo/day/yr) (mo/day/yr) Current $ Concurrent of $ Prior Prior $ Prior $ 5. I certify that the information submitted is true and correct: Name Date Title ES331 (6/04)